Addressing cancer disparities through community engagement: improving breast health among Haitian women.

Cancer is a significant part of the national dialogue on health disparities and is a priority for Healthy People 2010 (Smedley, Stith, & Nelson, 2003; U.S. Department of Health and Human Services, 2006). The ultimate causes of cancer disparities are not well understood but likely arise from a complex interplay of factors that impede awareness about screening and limit access to preventive and follow-up care; such factors include, but are not limited to, low socioeconomic status, culture, education level achieved, literacy, social injustice, and poverty (Albano et al., 2007; Braveman & Gruskin, 2003; Chu, Miller, & Springfield, 2007; Singh, Miller, Hankey, & Edwards, 2003). The factors affect access to care and cancer survival and yield an uneven distribution of cancer morbidity and mortality that substantially affects marginalized and disadvantaged populations (Brookfield, Cheung, Lucci, Fleming, & Koniaris, 2009). For example, African American women are disproportionately burdened with poor breast and gynecologic cancer outcomes, often as a result of late-stage diagnoses (Tammemagi, 2007). As a result, identifying special populations that suffer a heavy burden of cancer, determining the causes, and applying relevant interventions to eliminate the disparities are critical (Freeman, 2004). Immigrants living in the United States are a special population that is impacted heavily by health disparities. International-born status has many implications for women regarding healthcare access, including breast and cervical cancer screening (Goel et al., 2003). For example, immigrant women from ethnically diverse populations tend to have lower incidence but higher mortality from breast cancer; reasons most often cited for this disparity are structural in nature (e.g., late presentation because of limited access to care, healthcare navigation miscommunications, low English proficiency, citizenship status, economic marginalization, social conditions that arise from a combination of these factors) (Andrulis & Brach, 2007; de Alba, Hubbell, McMullin, Sweningson, & Saitz, 2005; Echeverria & Carrasquillo, 2006; Seeff & McKenna, 2003). In addition, immigrant women often experience more breast and cervical cancer and mortality than women born in the United States because of a lack of preventive care access in their countries of origin (Kramer, Ivey, & Ying, 1999; Lewis, 2004) and belief systems incongruent with preventive screening behaviors (Consedine, Magai, Spiller, Neugut, & Conway, 2004; McMullin, De Alba, Chavez, & Hubbell, 2005; Suh, 2008). In general, cancer education and outreach in Haitian communities in the United States has been met with difficulties because of Haitian immigrants’ fatalistic orientations toward cancer (Consedine, Magai, & Neugut, 2004; David, 2001). Such orientations are understandable given the lived realities and context of experience that immigrant women may draw upon for reference. A recent study that assessed colorectal cancer knowledge, attitudes, and beliefs among Haitian adults indicated many misperceptions about cancer; however, focus group participants displayed a willingness to follow physicians’ advice (Francois, Elysee, Shah, & Gany, 2008). Cities in Florida contain large and growing Haitian communities that contribute to the rich diversity of the region. An examination of the health profile of the country of origin and an understanding of health beliefs, practices, and structural constraints in the social context of immigration are key concepts to inform thinking about the potential gravity of a health issue and how best to approach intervention design. The elements suggest a need for an interdisciplinary team of healthcare providers, community partners, and academic researchers to address social, cultural, political, clinical, and public health aspects that combine to affect the disease process in immigrant populations. This article describes the process of linking national directives to local needs through community partnerships and engagement using effective health education and outreach strategies in the Haitian community in Tampa, FL. Most women participants in the outreach and education programs were Haitian immigrants, as opposed to women of Haitian ethnicity born in the Unites States. The use of a systematic model for designing audience-appropriate cancer communications is presented. The five-pronged approach illustrates the importance of various factors that contribute to successful interventions in community outreach programs. The example provided in this article is specific to breast cancer education but can be applied to other subject matter across the spectrum of cancer care.